Nauvoo Pharmacy, PLLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054007478 Issued in IL

Legal business name

NAUVOO PHARMACY, PLLC

Practice address

1350 Mulholland Street
Nauvoo, IL 62354

Phone

(217) 453-2717

Fax

(217) 453-6456

NPI assigned

Mar 27, 2009

Last updated

Feb 17, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mattie Ann Haas, PHARMDNPI 1235520644

Title

Pharmacist/Owner

Phone

(217) 453-2717

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Nauvoo Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Nauvoo Pharmacy, PLLC

  • Community/Retail Pharmacy
  • Nauvoo, IL
  • NPI 1740914654
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mattie Ann Haas, PHARMD

  • Pharmacist
  • Nauvoo, IL
  • NPI 1235520644
  NPD Authorized official
• Lauren Carlisle

  • Pharmacist
  • Nauvoo, IL
  • NPI 1528713997
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1205078847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "address_2": "1350 MULHOLLAND STREET",
            "city": "NAUVOO",
            "state": "IL",
            "postal_code": "62354",
            "telephone_number": "217-453-2717",
            "fax_number": "217-453-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 MULHOLLAND STREET",
            "city": "NAUVOO",
            "state": "IL",
            "postal_code": "62354",
            "telephone_number": "217-453-2717",
            "fax_number": "217-453-6456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAUVOO PHARMACY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-27",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "MATTIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "217-453-2717",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "054007478",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054007478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3711031796235401",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory A Miller, MD
• David E. Morgan, D.C.
• Nauvoo Colusa Cus Dist 325
• Nauvoo Fire Protection District
• Nauvoo Health & Chiropractic
• Nauvoo Pharmacy, PLLC
• Mary Ann Siegworth, SLP
• Anthony William Wasielewski, APRN-BC

• Community/Retail Pharmacy in Nauvoo, IL
• Providers in Nauvoo, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.